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Days | BS Description E | ICD | IOS BS | CPT | PACKAGE | Price | Center |
|---|---|---|---|---|---|---|---|
0 | CLASS I MALOCCLUSION W/SPACIMG-FIXED | 320063 | 7,700.00 | ||||
0 | CLASS II D1 SINGLE ARC EXTRACT-FIXED | 320064 | 8,400.00 | ||||
0 | CLASS II D2 NON EXTRACTION-FIXED | 320065 | 7,700.00 | ||||
0 | CLOSING DIASTEMA | 320066 | 1,900.00 | ||||
0 | ROTABLATOR (ATHERECTOMY) SINGLE VESSEL AS | 310200 | Y | 14,000.00 | |||
ADDITIONAL SERVICE * CORONARY INTERVENTION | |||||||
0 | RV to PA CONDUIT (ALONE) | 310201 | 3875700 | 40,000.00 | |||
0 | RV to PA CONDUIT(COMBINED WITH ANOTHER | 38507-00[611] | 310203 | 3875402 | 20,000.00 | ||
PROCEDURE) | |||||||
0 | RVOT RESECTION (ALONE) | 38507-00[611] | 310205 | 3850700 | 40,000.00 | ||
0 | RVOT RESECTION(COMBINED WITH ANOTHER | 90596-00[1378] | 310207 | 3850800 | 20,000.00 | ||
PROCEDURE) |
CLASS I MALOCCLUSION W/SPACIMG-FIXED
7,700.00
CLASS II D1 SINGLE ARC EXTRACT-FIXED
8,400.00
CLASS II D2 NON EXTRACTION-FIXED
7,700.00
CLOSING DIASTEMA
1,900.00
ROTABLATOR (ATHERECTOMY) SINGLE VESSEL AS
14,000.00
ADDITIONAL SERVICE * CORONARY INTERVENTION
RV to PA CONDUIT (ALONE)
40,000.00
RV to PA CONDUIT(COMBINED WITH ANOTHER
20,000.00
PROCEDURE)
RVOT RESECTION (ALONE)
40,000.00
RVOT RESECTION(COMBINED WITH ANOTHER
20,000.00
PROCEDURE)
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